City Doc

Years of work in the emergency department persuaded Leana Wen, MD, MSc, to make a classic public health pivot. She wanted to help patients upstream, help them prevent problems that would send them to the hospital. As Baltimore City health commissioner, Wen is responsible for a $130 million budget, 1,000 staff and, more importantly, the health of the city. Since her 2015 appointment, Wen sees herself as doctor for the city. In a revealing conversation with Shazeen Suleman, MD, MSc, a Sommer Scholar, Wen shares her goals for health in the city and her thoughts on the nature of public health leadership.

SS: What kind of leader are you?

LW: I lead from my heart. I lead through my values and principles, I lead through my experiences, I lead through who I am. I bring my passion to my job, and a dedication that is deep-rooted to who I am.

SS: As students, we hear time and time again, “Follow your passion.”

LW: I think that “following one’s passion” is interpreted by so many students as waiting for that perfect opportunity, when in fact that perfect opportunity is whatever people can take action in right here and right now. So, don’t wait until you can work with patients with HIV in sub-Saharan Africa. If you’re passionate for HIV, work on HIV right here. Or if it’s to work in underserved communities, don’t wait until you can go abroad and have that perfect opportunity. Get started on that now.

In the emergency department, I saw many examples of how our system failed our patients....I wanted to address these systemic failures, and to change the system.

SS: What are some of the values you bring to your job and leadership?

LW: Three things. First is protecting the most vulnerable. Second is leveling the playing field of inequity. Third is health is foundational to everything else.

SS: Why did you make the switch from practicing full-time in emergency medicine to your current role?

LW: In the emergency department, I saw many examples of how our system failed our patients. I saw patients with addiction go months without care. I saw patients fall through the cracks all the time because they lacked basic services that were not health care but health related. I wanted to address these systemic failures, and to change the system. This job is that ideal opportunity to do that. I see myself in this role as a doctor for the city.

SS: I’m from Toronto, Canada, and as I’m learning about some of the systemic failures here in Baltimore, I can’t help but think how many communities around the world have the same problems. What do you think is one lesson that communities can learn from us?

LW: We have been formulating our strategy for Healthy Baltimore 2020, which is our blueprint for health in the city. We realized that in this city, where we have the best medical care that’s available, it’s unconscionable for us to have such profound disparities. So, our Healthy Baltimore 2020 is going to be calling out [and] reducing disparities, and we now have equity metrics for every one of our health metrics. Addressing that fundamental issue of equity is foundational to health and well-being as well. We hope that other places will also look at our example and see that just improving health overall isn’t moving the needle unless we can also improve health for everyone.

SS: How did you come up with that metric?

LW: We are approaching our work from a race equity and inclusion framework. That’s particularly important in cities like ours. There is structural racism, there are policies of discrimination; policies that have promoted police brutality and mass incarceration that have led us to where we are. We have to call out specifically that poverty is a public health problem, that violence is a public health problem, that racism is a public health problem.

SS: What’s the biggest public health challenge 10 years from now?

LW: I don’t know that I can specifically say the one thing that will be the most important, but I will say that it’s important for us to acknowledge that issues that are not traditionally thought of as being health problems are. Housing, for example, is absolutely health care. Poverty absolutely ties into health. Injustices and inequities in general tie into health. All of those are what we must consider as problems and must be part of our solution as well.

SS: I like how you describe it all as health, not just an individual entity, but tied together with so many other frameworks. One thing that’s resonating in my mind, especially as students, is early in our career we move into communities that are new to us. How do you build relationships with communities?

LW: We hire individuals in recovery themselves to speak with our patients with addiction. We hire people living with HIV to talk about stigma and to work with patients with HIV. It requires intentional recruitment. It requires intentional engagement. Everything that we do is with the community every step of the way. That is how public health needs to be.

SS: If you’re working with the community, undoubtedly you’ll have to work with politicians. What do you think the role of politics is in public health leadership?

LW: We in public health must always be cognizant that we represent the voice of science, the voice of evidence, the voice of physicians, the voice of health professionals; we must always be seen as the impartial individuals giving advice. Our job is to take the seat at the head of the table. When health is about everything, we need to make sure that health is also incorporated into every discussion and in fact is leading each of these discussions.